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2009 Carrier/A/B MAC Update

2009 Annual Carrier Update

The SNF consolidated billing files reflect new codes that have been developed for 2009 and codes that have been discontinued for 2009. In addition, the files reflect any additions and deletions to categories of services excluded from consolidated billing. These files are effective for claims with dates of service on or after 1/01/2009 unless otherwise noted.

File 1 - Part A Stay - Physician Services (see file below)

Note: Services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part A covered stay. They should be submitted to the Part B Medicare carrier or Durable Medical Equipment Regional Carrier, as appropriate, for payment consideration.

June 2009 – The following codes when billed globally, or as a separate technical component or professional component billed with a TC or 26 modifier, are excluded from consolidated billing and may be paid separately by the Medicare Part B contractor: 78804, 79200, 79300, 79403, and 79440. These codes therefore appear on both File 1 and File 2.

April 10, 2009 - It has come to our attention that the code L5670 was inadvertently left off of File 1. This code should be allowed to pay separately outside of the SNF consolidated billing bundled payment to the SNF. Should you have received a denial for L5670 for claims with dates of service on or after January 1, 2009, please contact your DMAC to have the claim re-opened and re-processed. The code will be added to File 1 with the next scheduled quarterly update in October 2009.

File 2 - Part A Stay - Professional Components of Services to be Submitted with a 26 Modifier (see file below)

Note: The professional component of the services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing and will be considered for payment by the Part B Medicare carrier for Medicare beneficiaries in a SNF Part A stay. These codes must be submitted with a modifier of 26 to indicate "professional component".

File 3 - Part A Stay - Ambulance (see file below)

Note: These are ambulance codes that will always be denied by the Part B Medicare carrier for Medicare beneficiaries in a skilled nursing facility Part A covered stay when submitted with an NN modifier. Effective 10/4/04, per Transmittal 163, these ambulance codes will also be denied when submitted with modifiers ND or DN.

File 4 - Part B Stay Only - Therapy Services (see file below)

Note: Services represented by these codes are the only services subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part B stay. The file includes codes for physical, occupational and speech therapy. The Part B Medicare carrier will always deny these codes for Medicare beneficiaries in a SNF Part B stay. Therapy services must be provided and billed under arrangement with the SNF.